Appointment Forms

To reduce your waiting time, please complete the appropriate forms and bring them with to your appointment.

Mammography:

• Mammography Patient History Form
• Historial del Paciente para Mamografia
• Acknowledgement of Notice of Privacy Practices
• Garantia De Noticia De Privacidad

DEXA/Bone Density Exam:

• Bone Density Screening Patient History Form
• Cuestionario De Medicion De La Masa Osea
• Acknowledgement of Notice of Privacy Practices
• Garantia De Noticia De Privacidad

X-ray Patients:

• X-ray Patient History
• X-ray Patient History (en Español)
• Acknowledgement of Notice of Privacy Practices
• Garantia De Noticia De Privacidad

Uterine Fibroid Embolization Consultation:

• Patient History Form

Varicose Vein Consultation:

• Patient History Form

All Other Patients:

• Acknowledgement of Notice of Privacy Practices
• Garantia De Noticia De Privacidad

Please also remember to bring your most current insurance card to ensure the information (group number, provider number, etc.) is valid at the time of service. Incorrect or out-of-date information will delay your claim and you may be held responsible for full payment of the claim.